Review question:

Is email an effective method of communicating the results of diagnostic medical investigations to patients?

Nursing Implications:

The communication of diagnostic investigation results, such as blood tests, may be part of a nurse’s everyday role. Email is a communication medium through which nurses and other members of the multidisciplinary team could convey test results to their patients. However, professionals need to be reassured of the security, reliability, acceptability and effectiveness of this approach. A systematic review was therefore warranted.

Study Characteristics:

This is a summary of a Cochrane systematic review. The review was one of a suite focusing on the use of email in clinical practice. The other reviews evaluated studies of email to coordinate healthcare appointments; to support health promotion; to facilitate clinical communication between practitioners and patients; and to allow clinical discussion between healthcare professionals. The literature search was carried out in January 2010.

The review sought to compare the safety and effectiveness of using email to communicate results of any diagnostic medical investigations; compared to using SMS/text messaging, telephone or other methods of communication such as face-to-face or postal letters.

The review sought randomised controlled trials (RCTs), quasi-randomised trials, controlled before-and-after studies, and interrupted time series. Studies from all settings - such as outpatient clinics, primary care, community and hospital settings would have been included. Study participants included patients, caregivers, administrative staff and any type of healthcare professional (e.g. doctor, nurse, allied health professional). Use of email considered to be an appropriate intervention included unsecured email messages, secured (encrypted) email messages and web messaging.

The outcomes to be explored within the review were whether email messages had been understood and acted upon correctly by patients; whether there were any effects on safety and quality of care; and whether email was considered – by professionals and patients – to be an appropriate method of communication in this context. There was also interest in the resource implications (e.g. time and cost) of using email to communicate test results.

Summary of Key Evidence:

A common literature search was carried out for the suite of five reviews focusing on the use of email in health care. Though a total of 26 articles were included across all five reviews, none studied the use of email to communicate test results.

The review authors suggested that the lack of specific studies may have been due to the practice of emailing test results sitting within the broader role of email in the support of healthcare administration. They also suggested that publication bias may have resulted in inconclusive or negative studies of this intervention being unavailable within the literature. Finally, authors noted that suitable studies may have been published in the time that had passed since the literature search.

Best Practice Recommendations:

The lack of studies meant that no best practice recommendations could be made. However, the review does highlight the need for RCTs to evaluate the specific use of email to communicate test results to patients.